• New research links premature menopause to a higher lifetime risk of heart disease.
• Premature menopause means going into menopause before age 40.
• The findings suggest reproductive history should factor in heart health assessments, experts said.

Starting menopause earlier than age 40 puts women at a higher lifetime risk of heart disease than those who start later, according to a large new study. The research, published in JAMA Cardiology, found that women who experience natural premature menopause—defined as menopause beginning before age 40—are about 40% more likely to develop coronary heart disease throughout their lives than women who begin menopause earlier. 

This paper is the first to examine this link over a lifetime, and its findings “reinforce that menopause timing isn’t just a reproductive issue—it’s also a heart health issue,” said Priya Freaney, MD, the study’s lead author and an assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine.

Gathering Heart Disease and Menopause Data

Previous studies have shown that starting menopause—technically defined as one year after a woman's last menstrual period—at a younger age is linked to an increased short-term risk of coronary heart disease. In 2019, the American College of Cardiology/American Heart Association Primary Prevention guidelines recognized premature menopause as an established cardiovascular disease risk factor. 

But for this study, researchers aimed to understand the threat over a lifetime. “By looking at lifetime risk, we hoped to better capture the long-term impact of premature menopause on heart health and help inform prevention earlier,” said Freaney, also the director of the Women’s Heart Care Program at Northwestern Medicine Bluhm Cardiovascular Institute.

Freaney and her colleagues analyzed data from just over 10,000 post menopausal women, ages 55 to 69, who participated in six long-running U.S. studies included in The Cardiovascular Disease Lifetime Risk Pooling Project between 1964 and 2018. The group was about evenly split between Black and white women—none had coronary heart disease at baseline, and all experienced natural, not surgical, menopause.

Premature Menopause Linked to Higher Heart Disease Risk

Over the study period, coronary heart disease events, including heart attacks and deaths from heart disease, occurred in 260 Black women and 748 white women. Premature menopause was more common among Black participants (just over 15%) than white participants (about 5%), which Freaney said may reflect a mix of social, environmental, and health factors.

After accounting for factors such as smoking, obesity, hypertension, and diabetes, premature menopause was associated with a 41% higher lifetime risk of coronary heart disease for Black women and a 39% increased risk for white women.

Notably, women with premature menopause didn’t develop heart disease significantly earlier than others, meaning they spent a similar number of years free of the condition despite their higher overall risk.

The study has some drawbacks, however. Participants self-reported menopause data, which may have introduced inaccuracies. Researchers also didn’t account for the use of hormone therapy or cardiovascular risk factors, such as PCOS and hypertensive disorders of pregnancy, both of which could influence heart disease risk. 

What's Behind the Connection?

Beyond these limitations, researchers still don’t fully understand why premature menopause may be linked to a higher lifetime risk of heart disease—or the increased short-term risk seen in earlier studies—but estrogen likely plays a key role, Ryhm Radjef, MD, director of the Henry Ford Health Women’s Heart and Cardio-Obstetric Program, told Health.

Estrogen has protective effects on the heart and blood vessels, and levels drop during menopause. Losing that protection earlier in life may raise cardiovascular risk, Radjef explained.

“Early menopause might also reflect [underlying] inflammation or metabolic changes that can lead to heart disease,” she added. “In that sense, premature menopause may be both a cause and a marker that a woman is at higher risk and may benefit from earlier cardiovascular prevention.”

How to Protect Your Heart During Menopause

The new study’s long follow-up time and large, diverse sample helps put the size of this risk into clearer perspective for both patients and practitioners, Freaney said.

It also adds to growing evidence that reproductive history should factor into risk assessments, helping flag women who may be vulnerable earlier in life, Radjef noted. From there, clinicians can focus on prevention—managing blood pressure, cholesterol, and metabolic health. 

More broadly, experts said menopause is a key time to double down on heart-healthy habits: staying active, eating well, maintaining a healthy weight, avoiding smoking, and monitoring blood pressure, cholesterol, and blood sugar.

“Menopause is an important time to pay closer attention to heart health,” Radjef said. “Addressing these factors early can significantly reduce the risk of heart disease later in life.”

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Kristina Dawson